CAJ | 학술논문

目的总结单中心手术结合微创的杂交技术,同期治疗弓部、胸腹段主动脉病变的经验.方法回顾性分析2007年6月至2008年5月在澳门仁伯爵综合医院应用杂交技术,同期治疗主动脉病变5例的临床资料.其中胸降主动脉瘤累及半弓合并夹层1例,弓降主动脉瘤1例,DebarkeyⅢ型急性主动脉夹层1例,累及双侧髂总、髂内动脉的肾下腹主动脉瘤2例.弓部近端锚定区分类,ZAP 0区2例,ZAP 2区1例.弓降主动脉瘤正中开胸行升主动脉至双侧颈总人工血管搭桥+左颈总动脉至左锁骨下动脉搭桥术,同期导管室血管造影(digital seduction angiogram,DSA)下经股动脉释放Zenith覆膜支架.Debakey Ⅲ型夹层行左颈总至左锁骨下动脉搭桥后释放覆膜支架封闭破口.对于累及双侧髂内动脉的腹主动脉瘤,预先髂内、外动脉搭桥后释放腹主动脉分叉支架.结果手术5例均获成功,术后即刻造影和随访CTA无内漏发生,随访期2～10个月.出血量约200～600 ml之间,均未输血.1例弓部杂交术后相继发生成人呼吸窘迫综合征(adult respiratory distresssyndrome,ARDS),及急性左心衰,经积极治疗后痊愈.1例术后因心肌梗塞死亡.2例弓部杂交治疗病例各颈动脉阻断时间均小于10 min,均无神经并发症或者轻微神经症状.另1例腹主动脉瘤患者杂交术后恢复正常,无并发症.结论应用手术结合微创这一新型杂交技术治疗胸腹各段主动脉病变,有利于减少外科创伤和体外循环等所带来的血流动力学改变.
목적 총결단중심수술결합미창적잡교기술,동기치료궁부、흉복단주동맥병변적경험.방법 회고성분석2007년6월지2008년5월재오문인백작종합의원응용잡교기술,동기치료주동맥병변5례적림상자료.기중흉강주동맥류루급반궁합병협층1례,궁강주동맥류1례,DebarkeyⅢ형급성주동맥협층1례,루급쌍측가총、가내동맥적신하복주동맥류2례.궁부근단묘정구분류,ZAP 0구2례,ZAP 2구1례.궁강주동맥류정중개흉행승주동맥지쌍측경총인공혈관탑교+좌경총동맥지좌쇄골하동맥탑교술,동기도관실혈관조영(digital seduction angiogram,DSA)하경고동맥석방Zenith복막지가.Debakey Ⅲ형협층행좌경총지좌쇄골하동맥탑교후석방복막지가봉폐파구.대우루급쌍측가내동맥적복주동맥류,예선가내、외동맥탑교후석방복주동맥분차지가.결과 수술5례균획성공,술후즉각조영화수방CTA무내루발생,수방기2～10개월.출혈량약200～600 ml지간,균미수혈.1례궁부잡교술후상계발생성인호흡군박종합정(adult respiratory distresssyndrome,ARDS),급급성좌심쇠,경적겁치료후전유.1례술후인심기경새사망.2례궁부잡교치료병례각경동맥조단시간균소우10 min,균무신경병발증혹자경미신경증상.령1례복주동맥류환자잡교술후회복정상,무병발증.결론 응용수술결합미창저일신형잡교기술치료흉복각단주동맥병변,유리우감소외과창상화체외순배등소대래적혈류동역학개변.
Objective Repair of aortic arch aneurysm is technically demanding and usually requiring complex circulatory management. Operative morbidity and mortality may be prohibitive with traditional surgical intervention. We described our experience with 5 hybrid endovascular procedure for aorta repair with different kinds of bypass followed by concomitant placement of stent graft in the aorta. Methods We retrospectively reviewed the clinical data of 5 consecutive patients presenting with aortic aneurysm or dissection from 2007 to 2008 treated by the hybrid aorta repair. Complete surgical rerouting of the supra-aortic vessels was followed by endovascular repair of aortic arch aneurysm with a Zenith TX2 stent graft. Hybrid left carotid-subclavian bypass with Zenith stent graft deployment covering the ostium of the LSA was performed in a Debakey type Ⅲ aortic dissection case. Procedures were successfully completed with exclusion of the aortic aneurysm. All stent grafts were deployed retrograde from the femoral artery in these patients. Results Technical success with complete aneurysmal exclusion was achieved in all patients (100%). At a follow-up period of 2-10 months, there was no incidence of endoleak. Documented perioperative neurelogic events did not occurred in all patients. Postoperatively one patient suffered from ARDS and cardiac failure and recovered. One patient died of myocardial infarction. Conclusions Hybrid arch repair provides an alternative to patients otherwise considered prohibitively high risk for traditional open arch and thoracoabdominal aorta repair.